Exercise Guidelines for People with Polio:

A Guide for Physiotherapists

POLIO
SERVICES
VICTORIA
A Polio Services Victoria Production Published October 2005

Introduction
Polio is an anterior motor horn cell disease, which can lead to partial or complete muscle
paralysis. Between 25 – 75% of paralytic polio survivors develop post-polio syndrome
(PPS), which is characterised by new or increased muscle weakness, fatigue or pain.
Exercise prescription for people with polio is different compared to non-polio sufferers and
this must be considered when prescribing exercise for this population.

Pathophysiology of Affected Muscles

In the acute stage of polio when motor
units are destroyed, surviving motor units
sprout axons to reinnervate the
denervated or “orphaned” muscle fibres.
This process of denervation and
reinnervation is ongoing over the muscle
lifespan. As a consequence, polio-
affected muscles have oversized motor
units and increased muscle fibre density.
However, physical symptoms such as
weakness and pain may remain stable for
many years. Later in life, new disabling
problems may emerge for people with a
history of polio. These can be described as
PPS or the “Late Effects of Polio” (LEOP). A
possible mechanism for the development of
new muscle weakness or fatigue in this
population is a reduction in the functioning
motor unit pool. There is emerging evidence
that when a critical threshold is reached, motor
neuron reinnvervation can no longer keep
pace with denervation. As a consequence
polio-affected muscles become deinnervated
and clinically, a disproportionate decline in
function is observed.

Exercise Considerations
Exercise Guidelines
• Low-moderate Muscle strengthening may be performed in muscles with residual poliomyelitis weakness,
intensity
however strength gains may be slower or limited compared to muscles unaffected by polio.
Clearly, no strength can be achieved in completely paralysed muscles after the acute
• Short duration
period because the motor units are completely destroyed and the damage is permanent.
• Regular rests,
with adequate Polio affected muscles are more susceptible to fatigue and have a prolonged recovery time
time for muscles compared to unaffected muscles. This may be explained by the increased workload on
to recover remaining motor units, which are compensating for lost motor units that were destroyed by
• Do not exercise polio. Individuals with PPS are even more susceptible to muscle weakness and fatigue,
to point of therefore more caution should be taken with exercise prescription.
muscle fatigue
• Monitor changes Some individuals with polio are anxious about exercising because early anecdotal studies
revealed loss of strength with exercise (due to excessive activity) and the press advised
in fatigue,
against exercise. Contrary to earlier studies, research within the last 20 years
muscle soreness demonstrates that modified exercise is beneficial for the polio population with or without
and weakness PPS and that it has no adverse affects. Although modified exercise has been shown to be
and let this beneficial, the current research is inconclusive regarding specific exercise prescription.
guide exercise The general exercise guidelines provided here have been extrapolated from the available
prescription literature and clinical experience with polio patients.
 Exercise Guidelines for People with Polio:
A Guide for Physiotherapists

POLIO
SERVICES
VICTORIA
A Polio Services Victoria Production Published October 2005

Exercise Guidelines
Be aware that exercise programs for polio patients require closer monitoring than the
normal population because there is a risk of muscle weakness and fatigue due to excessive
exercise. Every exercise program must be specifically tailored to the individual’s functional
status and needs. Exercise should not overly fatigue the patient because this may lead to
POLIO an increase in chronic fatigue levels and muscle weakness, thereby decreasing the
SERVICES
VICTORIA patient’s functional level.

Strengthening Exercise
St Vincent’s Hospital Manual muscle testing must be performed before and during the exercise program to
Melbourne closely monitor changes in muscle strength. General recommendations for strengthening
exercise are: low resistance, high repetitions and frequent rest periods of sufficient duration
Bolte Wing to allow recovery from muscle fatigue. For example, a study showed that the following
14 Nicholson Street exercise program was effective: 3 low-resistance sets of 8 repetitions (with a 5 minute rest
Fitzroy, 3065 between sets), 3 times a week with a rest day between exercise days.1
℡ 9288 3900
℡ 1800 030 324 Cardiovascular Exercise
Fax 9288 3808 Excessive cardiovascular exercise has been shown to increase levels of chronic fatigue.
E-mail: However some amount of exercise is necessary for improving cardiovascular fitness.
psv@svhm.org.au Therefore the correct level of exercise must be determined in order to gain maximal
cardiovascular fitness without worsening levels of chronic fatigue. The major principles are
to exercise at a moderate (rather than maximal) intensity, have short sessions with frequent
Multidisciplinary rests and have adequate recovery time between session days. For example, one study
Team: found the following program effective: 20 minute sessions with frequent short rests as
needed, 3 times a week with at least one day off in between sessions.2
Rehabilitation Medicine
Specialist Hydrotherapy is another form of exercise which has been shown to be beneficial for this
Physiotherapist population in maintaining function and providing positive social interaction.3
Orthotist
Occupational Therapist Please contact the physiotherapist at Polio Services Victoria for any queries regarding
exercise prescription in this population. Also feel free to contact Polio Services Victoria for
further information or a discussion on the articles listed below.
Clinics: References
Specialist Assessment
Treatment Planning
1. Chan K et al (2003): Randomised Controlled Trial of Strength Training in Post-Polio
Metropolitan Patients. Muscle& Nerve 27:332-338.
Regional 2. Kriz J, Jones D and Speier J et al (1992): Cardiorespiratory Responses to Upper
Extremity Aerobic Training by Postpolio Subjects. Archives of Physical Medicine and
Rehabilitation 73:49-54.
3. Willen C, Sunnerhagen K and Grimby G (2001): Dynamic Water Exercise in Individuals
With Late Poliomyelitis. Archives of Physical Medicine and Rehabilitation 82:66-72.
4. Dean E and Dallimore M (2005): Muscle Function and Training of Individuals with
Chronic Effects of Poliomyelitis with and without Postpolio Syndrome. Physiotherapy
Canada 57:19-32.